Provider Demographics
NPI:1902004013
Name:JONES, DOROTHY JEANETTE
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JEANETTE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:JEANETTE
Other - Last Name:FELTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1004 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PORT GIBSON
Mailing Address - State:MS
Mailing Address - Zip Code:39150-2434
Mailing Address - Country:US
Mailing Address - Phone:601-437-3524
Mailing Address - Fax:601-437-3570
Practice Address - Street 1:1004 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-2434
Practice Address - Country:US
Practice Address - Phone:601-437-3524
Practice Address - Fax:601-437-3570
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0070580MedicaidIN-HOME RESPITE
MS00770582MedicaidHOMEMAKER